Cardiology Coding Alert

Hint: Code 93978 is for a complete study.

In the article “Ankle-Brachial Index Instrumental for Diagnosing Peripheral Artery Disease,” in Cardiology Coding Alert Volume 27, Issue 7, you learned all about ABIs, including the codes you would report and the guidelines you should follow.

Now, see what Elizabeth Herbert, RHIA, CPC, CDEO, CPMA, CRC, CCC, AAPC Approved Instructor, had to say about the additional imaging that may be necessary before peripheral artery disease (PAD) intervention, in her HEALTHCON 2024 session “Peripheral Artery Disease: Diagnostics and Treatments of the Lower Extremities.”

Read on to learn about three different types of imaging you may see in the documentation for PAD.

Type 1: Duplex Ultrasonography is Non-Invasive Test

One option for imaging is duplex ultrasonography, which evaluates the status of a patient’s vascular disease and provides information about hemodynamics, Herbert said. It’s non-invasive, doesn’t need contrast material, and is more readily available but highly technician-dependent.

Duplex ultrasonography is typically obtained for a more focused evaluation of localization of stenosis or to check stent or bypass graft patency, Hebert added.

The arterial duplex ultrasound codes you may see are as follows:

• 93925 (Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study) and 93926 (… unilateral or limited study). Note: Code 93925 is for the complete bilateral study and 93926 is for the unilateral or limited study. These codes are for duplex scans of the lower extremity arteries or arterial bypass grafts.
• 93930 (Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study) and 93931 (… unilateral or limited study). Note: These codes are for the upper extremity arteries or bypass grafts.
• 93978 (Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study) and 93979 (… unilateral or limited study). Note: Code 93978 is for the complete study, and 93979 is for the unilateral or limited study. These codes are for the aorta, inferior vena cava iliac vasculature, or bypass grafts in that area.

Type 2: Focus on CTA

Computed Tomography Angiography (CTA) is considered to be highly specific and sensitive when evaluating PAD, Herbert said. “They are great for evaluation of inflow disease or assessment of graft patency. They are relatively inexpensive and quick but with disadvantages of IV [intravenous] contrast use and radiation exposure.”

CTA codes you may see include the following:

• 73706 (Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing). This code is for the lower extremity, and it has a medically unlikely edit (MUE) of 2, Herbert said.
• 75635 (Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing). This code is for the abdominal aorta and bilateral iliofemoral lower extremity runoff, Herbert said. It has an MUE of 1 since it’s bilateral.

Don’t miss: The Centers for Medicare & Medicaid Services (CMS) established MUE as a unit-of-service edit for HCPCS Level II/ CPT® codes. An MUE is assigned to a specific code to represent the maximum number of units of the code that you should report — either on a specific claim or on a specific date.

CMS developed the edits to reduce the paid claims error rate for Medicare claims.

Exceptions: For instance, when a provider legitimately exceeds the MUE frequency limit, Medicare has provided guidance for how to override an MUE value, using “distinct service” modifiers, such as 59 (Distinct procedural service) or the X{EPSU} modifiers.

Alert: The MUE table includes a column for “MUE Adjudication Indicator” (MAI), which provides guidance about what circumstances allow you to override an MUE limit for a given code. If the code has an MAI of “1,” the code is adjudicated on a claim-line basis, meaning that you can’t exceed the number of MUE units on a claim line. You are allowed to use one of the distinct service modifiers to override the edit if circumstances allow.

An MAI of “2” means that the frequency limit is absolute for a date of service, and you may not override the edit with a modifier.

Type 3: Rely on 72198, 73725, 73725 for MRA

Magnetic Resonance Angiography (MRA) is comparable to CTA for evaluation of inflow disease and bypass graft patency but may be limited and give suboptimal assessment of stents due to artifact, Herbert said. MRAs are more time-consuming and costly than CTAs. The use could be contraindicated for some patients with implanted devices, and there may be a risk of nephrogenic systemic fibrosis from gadolinium in stage 4-5 chronic kidney disease (CKD) patients.

MRA codes you may see include the following:

• 73725 (Magnetic resonance angiography, lower extremity, with or without contrast material(s)). This code is for a lower extremity MRI, Herbert said. It has an MUE of 2.
• 74185 (Magnetic resonance angiography, abdomen, with or without contrast material(s)). This code is for an abdominal MRA, and it has an MUE of 1, per Herbert.
• 72198 (Magnetic resonance angiography, pelvis, with or without contrast material(s)). This code is for a pelvic MRA and has an MUE of 1, Herbert said.